Personal Fitness Professional - Spring 2018 - 17
For trainers working with children or young
adults, you should know that peak bone mass
occurs in the mid-20s. Think about bone density as savings in a bank. By saving or building
bone density when young, bones will have
more density as we age, decreasing the risk
of osteoporosis. Ensure that younger clients
are creating dense bones by participating
in high-impact activities. It is also important
to keep an eye on clients who are exercising
too much, causing exercise-induced amenorrhea. This will create the same issues as
postmenopausal women - an incidence of
low estrogen - one of the major factors in
the loss of bone mass.
PROGRAM SAFE, EFFECTIVE EXERCISES
The most effective exercises for preventing
osteoporosis and working with those already
diagnosed with this disease are
weight-bearing, resistance training, balance, posture, stress-reducing exercise, and impact
exercise. It will only be after your
client's fitness assessment that you
will be able to determine which
exercises should by emphasized
and which should be avoided.
Before working with someone
with osteoporosis make sure they
have provided you with medical
clearance from their physician. As with all your
clients with chronic conditions, you should be in
communication with their healthcare team.
A safe osteoporosis exercise program
consists of weight-bearing exercise for 150
minutes per week, but determine the amount
of training time as appropriate. By adding
strength training, using body weight or hand
weight, it will stimulate bone-building cells,
improve proprioception, and improve balance,
coordination and agility. Strength training increases bone density because when the muscle
contracts it pulls on bone. Slowly increasing
the weight used will increase the muscle mass,
which increases the pull on the bone.
Falls cause fractures, so fall prevention exercise (balance exercise and muscle strengthening) is crucial. Kyphosis affects balance so
posture exercise, concentrating on alignment,
is an important component of a safe program.
Start with a balance assessment. Have clients
try to balance on one leg for 10 seconds. If this
cannot be performed, they are level A. They
should perform all standing exercises while
holding a chair or barre. They can start with leg
raises after a gentle warm-up. Leg raises can
be performed by raising a straight leg upward,
to the back, and to the side for 10 repetitions.
Add calf raises and a gentle foot stomp,
and walking. Tai Chi, Qigong, and extremely
modified yoga and Pilates can also be added
for posture, balance, and stress reduction.
Level A clients should practice getting up and
down from a chair in squat form with various
assistance devices if necessary (if that move is
painful, continue with a straight leg exercise).
It is interesting to note that there is less osteoporosis in cultures where squats are a fundamental part of performing daily activities. Your
client should progress gradually. They should
listen to their body, not strain, use good form,
and stop if in pain.
KNOW WHAT IS UNSAFE
Fitness professionals need to know what
exercises are considered unsafe. Forward
bending is unsafe. Teach your clients to use a
hip hinge (neutral spine using legs) to protect
their spine. Any exercise such as an abdominal crunch is contraindicated. Extreme
twisting is unsafe. Therefore, many yoga and
pilates exercises must be modified. Pushing
heavy weight upward creates too much force
on a fragile spine, as does plopping down on
a chair or floor.
Group fitness instructors should ask if
their students have osteoporosis and always
provide modifications. Swimming and biking,
while excellent for cardiovascular health and
are easy on the joints, are not helpful for
building bones. They are not weight-bearing
exercises. If training on a bicycle, the back
should not be rounded.
For clients who like to exercise
in a gym, you should observe their
routine to make sure that their
technique is correct. We often see
individuals on the chest press and
chest fly machines, sitting in a forward bend posture, which is unsafe.
This forward bend posture can also
be observed on knee extension and
seated row machines.
Since your client is not with you 24
hours a day, they need to understand how to
perform their activities of daily living in a safe
manner. Driving, taking groceries out of the
car, brushing teeth, and making the bed must
be done in good spine alignment, using the
legs and avoid forward bending.
As a fitness professional, you can add great
value to your clients' quality of life beyond
your training sessions by educating your clients on how to prevent fractures during their
daily activities and manage living a strong,
healthy life even with osteoporosis.
A SAFE OSTEOPOROSIS EXERCISE
PROGRAM CONSISTS OF WEIGHT-BEARING
EXERCISE FOR 150 MINUTES PER
WEEK, BUT DETERMINE THE AMOUNT OF
TRAINING TIME AS APPROPRIATE.
If a client can balance on one leg for 20
seconds, they can perform leg lifts while holding onto a chair with two fingers, progress to
one finger and eventually adding leg weights
or a resistance band. They can jump with toes
on the ground, do a modified lunge (strength
and balance) and start walking up hills.
For clients who can balance easily on one
leg, they can perform leg lifts without holding
on to the chair, eventually adding leg weights,
and eventually adding another set and balance trainers can be introduced. The intensity
of their aerobic exercise of choice can start
to increase according to their history of fracture, orthopedic issues and general health.
Running is not considered safe for those who
experienced fracture without trauma.
Full body strength training is part of a safe
program for all fitness levels with the appropriate modifications. Start with light weights and
progress slowly, emphasizing the common
fracture sites of the hip, spine and wrist. For
those with hand arthritis, use wrist weights.
Carol Michaels is an author, consultant, national
presenter, founder of Recovery Fitness® and on
the boards of numerous health organizations. She
is the author of Exercises for Cancer Survivors and
created the Cancer Recovery course in partnership
with the National Federation of Professional Trainers. Carol was the 2012 PFP Trainer of the Year and
the 2016 IDEA Fitness Personal Trainer of the Year.
SPRING 2018 | WWW.PERSONALFITNESSPROFESSIONAL.COM | 17